A Retrospective Study Comparing Patient Self Reported Percepts using aValidated Sensitive Scale Questionnaire between Dermatologist Diagnosed SkinConditions in a Private Clinic Setting including Sensitive Skin Syndrome

Kam Tim Michael Chan1,2*

1Specialist in Dermatology, Hong Kong SAR, China

2Adjunct Professor of Master Course of Common Goods and Public Health, Baptist University of Hong Kong, China

ABSTRACTSensitive skin syndrome; albeit reported in many countries worldwide; remained a condition of unknown etiology

and pathogenesis. Some authorities speculate it as a skin condition continuum from mild to severe, its severity is

difficult to assess. Our retrospective study aimed to draw a one- year new patient’s attendee clinical data comparing

the patient self -reported percepts using a validated sensitive scale questionnaire between dermatologist diagnosed

skin conditions in a private clinic setting including sensitive skin syndrome. The results suggested that allergic contact

dermatitis, herpes zoster and sensitive skin syndrome diagnosed patients reported a similar mean Sensitive Scale-10

scores {46.07 (N= 91), 40.72 (N=35) and 41.38 (N=84); p >0.05} respectively. The mean SS 10 score was statistically

significantly different from other skin conditions like atopic dermatitis and seborrhea dermatitis and control. The

patterns of percepts distribution in terms of skin irritation, general discomfort, skin itchiness, tautness and pain

between allergic contact dermatitis, herpes zoster and sensitive skin syndrome were similar. Though pain is more

commonly reported it herpes zoster than itch. As how a patient perceives their somatic symptoms is one of the major

reasons for their dermatology health seeking behavior, our study suggested that extreme acute form of sensitive skin

syndrome may have a patient percepts similar to allergic contact dermatitis, herpes zoster psychosocially significantly

affecting quality of life of the sufferers.

Keywords: Sensitive skin syndrome; Severity; Percepts; Biopsychosocial model; Validated sensitive scale-10

questionnaire; Allergic contact dermatitis; Herpes zoster; Health seeking behavior

BACKGROUND

Percept is an impression or sensation of something perceived byan individual. It is the mental products of perceiving [1,2].Unpleasant percepts; maybe referred as dermatological symptomslike skin sensitivity, discomfort, itchiness, tautness and pain arethe main causes of patient’s health seeking behavior and visitingdermatologists. How an individual perceived their symptoms wasimportant influenced by multiple factors like personality,external stress, positive placebo or negative nocebo effects andsocial support. This biopsychosocial model had been shown tobe pivotal in many skin diseases influencing somatic symptoms

like the sensation or suffering itch through apsychoneurobiological mechanism [3-6].

In our study, data from a previously carried out pilotinvestigation on the prevalence of sensitive skin syndrome (SSS)in clinic setting was retrieved (period: 1st May 2018 to 31st April2019) [7]. The sensitive scores of a dermatologist diagnosedinflammatory and non-inflammatory skin conditions using avalidated sensitive scale questionnaire (SS-10) in SSS werecollected, analyzed and compared with the sensitive scores ofSSS. The objective of the study was to collect background data ofpatient ’ s perceived symptoms and sensitive scores using avalidated questionnaire and compare other dermatologist

Journal o

f Clin

ical

& Experimental Dermatology Research

ISSN: 2155-9554

Journal of Clinical & ExperimentalDermatology Research Research Article

Correspondence to: Kam Tim Michael Chan, Specialist in Dermatology, Adjunct Professor of Master Course of Common Goods and PublicHealth, Baptist University of Hong Kong, Hong Kong SAR, China, Tel: +852 21481133; E-mail: pioneerskin@ymail.com

Received: March 25, 2020; Accepted: April 8, 2020; Published: April 15, 2020

Citation: Chan KTM (2020) A Retrospective Study Comparing Patient Self -Reported Percepts using a Validated Sensitive Scale Questionnairebetween Dermatologist Diagnosed Skin Conditions in a Private Clinic Setting including Sensitive Skin Syndrome. J Clin Exp Dermatol Res.11:518. DOI: 10.35248/ 2155-9554.20.11.518

Copyright: © 2020 Chan KTM. This is an open-access article distributed under the terms of the Creative Commons Attribution License, whichpermits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

J Clin Exp Dermatol Res, Vol.11 Iss.2 No:1000518 1

diagnosed skin condition with SSS; a condition still with anundefined pathophysiological mechanism and unclearrelationship with other known skin dermatosis like allergiccontact dermatitis, atopic dermatitis, urticaria, acne vulgaris andherpes zoster.

METHODOLOGY

The survey complied to the ethical principles of the Helsinkideclaration (1983). Voluntary consents were obtained from theinterviewees and the self-reported questionnaire posed nomental risks to the participants.

OBJECTIVE

The objective of this study was to compare the sensitive scoresreported by the patients attending the private clinic in differenttypes of dermatologist diagnosed eczematous skin conditionslike atopic dermatitis, allergic contact dermatitis and noneczematous skin conditions like rosacea, seborrhea eczema,urticaria, acne vulgaris, psoriasis and infective skin conditionslike herpes zoster and tinea infection using a sensitive scalequestionnaire validated for SSS [8].

MEASURE

The sensitive scores (SS-10 scores) were measured with avalidated patient self-reported sensitive scale questionnaire(SS-10) translated in Chinese version [7,8]. It was usedpreviously to assess the severity of SSS and it has a good contentvalidity captures the cores percepts or symptoms of sensitive skinespecially in SSS. The Chinese version of the SS-10 had beenused previously to assess the sensitive scores of who sufferedfrom SSS and in a clinic based and community-based setting[7,9]. The collected data were used to determine the cutoff valueof diagnosing SSS using the validated SS-10 questionnaire usingthe receiver operating characteristics curve estimation. The

reports were presented and published [10]. SS-10 has been testedin more than 10 countries globally and had demonstrated goodpsychometric characteristics in measuring sensitive skin. SS-10was reported to have a high correlation with Dermatology LifeQuality Index (DLQI).

SS-10 scores were used as an estimate of skin sensitivity as manyskin conditions like allergic contact dermatitis, urticaria, tineainfection and herpes zoster described by clinic attendees asunpleasant percepts and somatic symptoms like sensations ofitch, pain and skin discomforts as sensitive skin.

PROCEDURE

During the period of 1st May 2018 to 31st April 2019 in aprivate dermatology clinic, all newly attended patients (N=1111)were asked voluntarily to fill in a validated SS-10 questionnaire.The SS-10 scores were recorded for all these clinic attendees andtheir clinical notes would record their respective clinicaldiagnosis by a dermatologist. The original aim of the study wasto collect the sensitive scores of clinically diagnosed SSS inclinic. Since the data set also included newly patient attendeesdiagnosed by dermatologist having eczematous skin conditionslike atopic dermatitis, allergic contact dermatitis and noneczematous skin conditions like rosacea, seborrhea eczema,urticaria, acne vulgaris, psoriasis and infective skin conditionslike herpes zoster and tinea infection; an evaluation andcomparison of the sensitive scores among these condition andSSS became feasible. The data set with the SS-10 scores with thecorresponding clinically diagnosed skin condition wereretrieved, recorded and analyzed retrospectively.

RESULTS

The number of patient dermatologist diagnosed eczematous,non-eczematous, infective skin conditions and SSS with theircorresponding average SS-10 scores were tabulated (Table 1).

Table 1: Total Number of Patients with a dermatological diagnosis = 1098 including patients diagnosed SSS and asymptomatic nodules, NS = nonsignificant (p>0.05).

Skin condition Diagnosed by Dermatologist Number of Patients Mean SS-10 Scores P<0.05 as compared with mean SS-10 scores ofSSS=41.38

Allergic Contact Dermatitis 91 46.07 NS

Herpes Zoster 35 40.72 NS

Urticaria 34 31.74 <0.05

Rosacea 26 26.00 <0.05

Atopic Dermatitis 74 26.53 <0.05

Seborrhea Dermatitis 33 23.79 <0.05

Tinea pedis 168 21.22 <0.05

Acne vulgaris 145 19.30 <0.05

Psoriasis 40 18.77 <0.05

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Control (Asymptomatic skin nodules like warts) 368 <10 <0.05

The mean SS-10 scores of allergic contact dermatitis, herpeszoster and sensitive skin syndrome are 46.07 (N= 91), 40.72(N=35) and 41.38 (N=84) which is statistically insignificant.

The mean SS-10 scores recorded in the study showed statisticallysignificant difference compared with other diagnosed skinconditions: urticaria, rosacea, atopic dermatitis, seborrheadermatitis, tinea pedis, acne vulgaris, psoriasis. The controlconsisted of clinically skin nodule like warts and pigmentedlesions scored less than 10 in the SS -10 scale.

Skin irritation, general discomfort, itching, tautness and painwere the commonest percepts reported in the study in ACD, HZand SSS. Itching is still the most common percepts reported inACD, SSS followed by HZ. Tautness followed a similar pattern.HZ reported more pain than ACD and HZ respectively.

The pattern of distribution of reported percepts was representedin Figures 1 and 2.

Figure 1: show the previously published cutoff value of SS-10 scoresto assess whether an individual suffered from sensitive skin (ACD =allergic contact dermatitis, HZ = Herpes zoster, AD= atopicdermatitis, SD = seborrhea dermatitis).

Figure 2: The breakdown scores of individual percepts of the SS-10questionnaire in the three dermatological skin condition diagnosiswith the highest mean SS-score.

DISCUSSION

Our retrospective clinical data analysis descriptively reportedthat in terms of patient ’ s percepts or clinically presentedsymptoms like skin irritation, general discomfort, skin itchiness,tautness and pain, ACD, HZ and SSS showed a similar meanSS-10 scores. This may have clinical and pathophysiologicalimplications. Firstly, as SSS is still an undefined clinical entity,the percepts reported by patients seeking health care attention iscomparable and maybe as severe as ACD and HZ which affectpatient’s quality of life. Is sensitive skin a disease, a syndrome, adisorder is still debatable, our reported data showed that severeSSS was a dermatological disorder warranted clinical care andmanagement of the suffering itch and percepts as in ACD andHZ [11]. Secondly, as the pattern of percept distribution betweenACD, HZ and SSS were similar, further research andinvestigations focusing on similar mechanisms mediating theseconditions were merited.

Based on a biopsychosocial model perspective, internal factorslike personality and external stress or adverse catastrophicfactors mediated by cognitive factors on how we think; e. g.negative thinking enhance a feeling of helplessness, worry andanxiety. While behavior factors like uncontrolled scratchingenhance the negative percept of discomfort, irritation and itch.Finally, social factors like lack of perceived social support maywork through psychoneurobiological mechanism in resulting inhealth seeking behavior of patients in SSS [3-6]. However, painhas been reported more in HZ compared with SSS and ACD, aneuropathic questionnaire maybe useful in assessing andcomparing patients in these conditions [12,13].

Currently, International Forum for the Study of Itch (IFSI)defined SSS as a syndrome by the occurrence of unpleasantsensations (stinging, burning, pain, pruritus, and tinglingsensations) in response to stimuli that normally should notprovoke such sensations [14]. These unpleasant sensationscannot be explained by lesions attributable to any skin disease.Till now, no known pathogenesis and proven treatment ormanagement care existed [15]. This definition is valid only as faras no additional data on the severity, patient ’ s percepts,behaviors and psychosocial determinants were available. If avalidated cutoff value was taken as SS-10 scores=25.5 whichshow that many skin conditions like atopic dermatitis, urticaria,rosacea may be associated with SSS and were part of the lessersevere spectrum of sensitive skin. On the other hand, if we lookat SSS as a skin condition continuum from mild to severe, ourclinic-based study observed that severe SSS may have asignificant disease percepts comparable to ACD and HZ withwell-defined clinical diseased entity which required medicalmanagement. From this perspective, it is arguable, whetheracute severe SSS with a mean SS-10 scores above 40 may beregarded as a dermatological disorder [11]. Most of the observedand diagnosed case of ACD are related to application of over thecounter, patient self-purchased cosmetics containing fragrances,toiletries, cleansers and topical cosmeceutical agents applied

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over the face, this raise the possibility whether SSS maybe acosmetic disorder or aggravating risk factor of ACD.

Our report has the following limitations including that it was aretrospective study retrieving information from a data set whichhas been already reported and published. ACD may havedifferent types like irritant or allergic while HZ patient maypresent to the clinic at different stages of the diseases. However,the total number of patients studied was 1111 from a one-yearperiod and the results were drawn from both a validatedsensitive score assessment SS-10 questionnaire and adermatologist clinical diagnosis, these may increase the validityof the results. Ways to improve or disprove the results of thestudy is to repeat the study with a specific aim to compare thepresented percepts of these three conditions, ACD, HZ and SSS,recruiting more patients and carrying out the study in otherclinical settings with both a validated sensitive skin andneuropathic questionnaire.

CONCLUSION

A retrospective study was carried out to compare the percept ofpatients attending a private clinic in Hong Kong within a one-year period. The percept and symptoms reported by the clinicattendees as measured by a validated SS-10 questionnaireshowed that ACD, HZ and SSS differ significantly from otherskin conditions. The commonest reported skin percepts are skinirritation, general discomfort, itching, tautness and pain. ACD,HZ and SSS reported a similar pattern in the SS-10 apart painwas more commonly reported in HZ compared with ACD andHZ. A biopsychosocial model through a psychoneurbiologicalmechanism involving neuroendocrine mediators like cortisol,endogenous opioids and oxytocin together with a validatedneuropathic questionnaire may worth further research andinvestigations.

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